Community Based HF Patients in the Last Year of Life
Community Based HF Patients in the Last Year of Life
Community based, ambulatory patients with CHF were identified from a clinical database used by the specialist heart failure nursing team in the local health authority. Patients were included if they had New York Heart Association (NYHA) class III or IV symptoms and were currently managed by the specialist heart failure nurse. Patients were excluded if they were due to be discharged from the heart failure nursing service within the following 6 weeks.
Each of four specialist heart failure nurses was interviewed, independently, with regard to the patients under their care. Nurses were asked to provide an answer to the GSF 'surprise question'—that is, "Would you be surprised if this patient died in the next 6–12 months?"; and to indicate whether or not the patient continued to have difficult physical or psychological problems, despite optimised treatment. The additional two criteria, NYHA class III or IV symptoms and two or more heart failure related hospital admissions within the last 12 months, were obtained from the clinical heart failure database (appendix 1).
Data required for the SHF were obtained from a local clinical heart failure database and a central patient electronic record system, including date of diagnosis; aetiology of heart failure; number of all-cause and CHF related hospital admissions during the 12 months before and after enrolment; total number of days spent in hospital during the 12 months before and after enrolment; and degree of left ventricular Hg) dysfunction. The most recent values for systolic blood pressure (mm weight (kg), haemoglobin concentration, total white blood cell count, lymphocyte count (percentage of total white cell count), urea and electrolytes, plasma cholesterol (mmol/l), plasma uric acid (if available), serum creatinine (sCr, μmol/l) and current medications were recorded. QRS duration on the most recent electrocardiogram, other medical diagnoses and comorbidities were also documented. These variables were imputed for each individual patient using the online SHF (http://depts.washington.edu/shfm/) to generate a value for 1 year predicted survival and mean life expectancy at baseline (appendix 2).
Data were analysed using SPSS (V.17) software. Data with continuous variables and a normal distribution were analysed using an independent samples t test. For nominal or categorical data, a χ analysis with a Pearson's test for significance was used. Sensitivity and specificity analysis was performed on nominal data in comparison with death at 1 year. The predicted survival data yielded from the SHF were also analysed using a receiver operator characteristic, area under the curve analysis using SPSS. All data for the study were acquired in accordance with the Data Protection Act (1998) and stored anonymously within secure National Health Service computer systems. The study was granted 'audit' status by a member of the South East Scotland Research Ethics Committee and was therefore not considered to require full ethical review.
Methods
Patient Selection
Community based, ambulatory patients with CHF were identified from a clinical database used by the specialist heart failure nursing team in the local health authority. Patients were included if they had New York Heart Association (NYHA) class III or IV symptoms and were currently managed by the specialist heart failure nurse. Patients were excluded if they were due to be discharged from the heart failure nursing service within the following 6 weeks.
Gold Standards Framework Criteria for Heart Failure
Each of four specialist heart failure nurses was interviewed, independently, with regard to the patients under their care. Nurses were asked to provide an answer to the GSF 'surprise question'—that is, "Would you be surprised if this patient died in the next 6–12 months?"; and to indicate whether or not the patient continued to have difficult physical or psychological problems, despite optimised treatment. The additional two criteria, NYHA class III or IV symptoms and two or more heart failure related hospital admissions within the last 12 months, were obtained from the clinical heart failure database (appendix 1).
The Seattle Heart Failure Model
Data required for the SHF were obtained from a local clinical heart failure database and a central patient electronic record system, including date of diagnosis; aetiology of heart failure; number of all-cause and CHF related hospital admissions during the 12 months before and after enrolment; total number of days spent in hospital during the 12 months before and after enrolment; and degree of left ventricular Hg) dysfunction. The most recent values for systolic blood pressure (mm weight (kg), haemoglobin concentration, total white blood cell count, lymphocyte count (percentage of total white cell count), urea and electrolytes, plasma cholesterol (mmol/l), plasma uric acid (if available), serum creatinine (sCr, μmol/l) and current medications were recorded. QRS duration on the most recent electrocardiogram, other medical diagnoses and comorbidities were also documented. These variables were imputed for each individual patient using the online SHF (http://depts.washington.edu/shfm/) to generate a value for 1 year predicted survival and mean life expectancy at baseline (appendix 2).
Data Handling and Statistical Analysis
Data were analysed using SPSS (V.17) software. Data with continuous variables and a normal distribution were analysed using an independent samples t test. For nominal or categorical data, a χ analysis with a Pearson's test for significance was used. Sensitivity and specificity analysis was performed on nominal data in comparison with death at 1 year. The predicted survival data yielded from the SHF were also analysed using a receiver operator characteristic, area under the curve analysis using SPSS. All data for the study were acquired in accordance with the Data Protection Act (1998) and stored anonymously within secure National Health Service computer systems. The study was granted 'audit' status by a member of the South East Scotland Research Ethics Committee and was therefore not considered to require full ethical review.
